Neuro and optho Uworld Flashcards
lacunar infarct causes what
pure unilateral motor impairment
pure sensory stroke
no visual field abnormalities
middle cerebral a occlusion signs
contra somatosensory loss contra motor loss
conjugate eye deviation toward infarct side
homonymous hemianopia
aphasia (if left hemisphere aka dominant)
hemineglect of the non dominant hemisphere (right)
anterior cerebral artery occlusion signs
contra somatosensory and motor deficit
mainly in lower legs
dyspraxia, emotional disturbances and urinary incontinence
most common cuases syringomyelia
spinal cord injury and arnold chiari malformations
what nerve controls hip and knee flexion
femoral
what causes intracranial HTN
trauma, space occupying lesions, hydrocephalus, impaired CNS venous outflow and idiopathic(pseudotumor cerebri)
patient with otitis and now mastoiditis, next step?
Brain CT to look for brain abscess, likely temporal
what type of neuronal signs in ALS
upper and lower
symptoms and signs of friedreich ataxia
necrosis and degeneration cardiac muscle fibers, myocarditis, myocardial fibrosis, cardiomyopathy
T wave inversion
T wave inverison alone is suggestive of what pathologie
myocarditis, MI, old pericarditis, Myocardial contusion and dig toxicity
what can cause carotid artery dissection
penetrating trauma
fall with object in mouth
neck maniputlation (yoga and sports)
personality change means that what lobe is affected
frontal
CT/MRI findings glioblastoma
butterfly appearance with central necrosis
what happens with prolonged seizures
cortical laminar necrosis
pronator drift is sensitive and specific for what
UMN injury
main risk factory for CP
prematurity
phenytoin use during pregnancy, child will have
fetal hydantoin syndrome
midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay
Aminoglycoside adverse effect
ototoxicity
what is used for absence seizures
ethosuximide and valproic acid
shakey baby syndrome will cause what inside
shearing subdural veins and retinal hemorrhages
course of presentation for intracerebral hemorrhage
focal neurologic symptoms early
later develop nausea and vomiting from ICP
brain death, still have preserved what function sometimes
DTRs
what dementia can cause visual hallucinations
lewy body
multuple circumscribed lesions on both sides of brain along junction grey and white matter
secondary mets
likely lung or melanoma
solitary brain masses are usually from what CA
breast, colon or renal cell
what is primidone used for
essential tremor
it converts into phenylethylmalonamide and phenobarbital
primidone may precipitate what
acute intermittent porphyria
how does acute intermittent porphyria present
abdominal pain, neuro and psychiatric abnormalities
how do Dx acute intermitten porphyria
check for urine porphobilinogen
Tx viral conjunctivitis
cool moist compresses
immediate manamgent of central retinal artery occlusion
ocular massage and high flow O2
Tx exertional heat stroke
immersion in ice water after stabilized with IV fluids
what are signs of uncal herniation
compression of contralateral crus cerebri causes ipsi hemiparesis
compression ipsi occulomotor nerve cause mydriasis ptosis and down out gaze
compression ipsi posterior a causes contralateral homonymous hemianopsia
compression reticular formation will cause LOC and coma
transtentorial uncal herniations can be secondary to what
space occupying lesions like epidural bleed
cushings reflex
HTN bradycardia and respiratory depression all from increased ICP
findings on MRI of meningioma
extra-axial well circumscribed and homogenously enhancing dural based mass
signs of niemann pick
loss of motor milestones, hypotonia, feeding difficulties cherry red macula
!! different the tay sachs because also will have hepatosplenomegaly and Areflexia
tay sachs has hyperreflexia
niemann pick is deficiency in what
spingomyelinase
next step for enlarging head circumference in child
CT of brain
complications of prematurity
RDS PDA bronchopulmonary dysplasia intraventricular hemorrhage necrotizing enterocolitis retinopathy
NPH is due to
decreased CSF absorption
how to check for phenylketonuria
quantitative aa analysis
or tandem mass spectrometry
signs phenlyketouria
severe intellecual disability
seizures
musty odor
hypopigmentation involing hair skin eyes and brain nuclei
incidence of Intraventricular hemorrhage is inversely proportional to what
birth weight
first line for migraines assoc with vomiting
prochloperazine (antiemetic)
presence of EBV DNA in CSF
primary CNS lymphoma
MRI of CNs lymphoma
ring enhancing mass that is solitary and periventricular
wallenberg syndrome
vertigo, fall to side of lesion
diplopia and nystagmus
ipsi limb ataxia
abnormal facial sensation or pain
loss of pain and temp ipsi face contra trunk and limbs
dysphagia and aspiration hoarseness ipsi horners intractable hiccups lack of automatic respiration
what artery occlusion causes wallenbergs
intracranial vertebral artery
side effects trihexyphenidyl
anticholinergic: blurred vision, constipation, vomiting
headache, dizziness, tachycardia
Tx myasthenic crisis
plasma exchange
CMV retinitis signs
yellow whiteish patches retinal opacification and retinal hemorrhages
Tx CMV retinits
ganciclovir or foscarnet
presentation sturge weber
focal or generalized seizures, mental retardation and port wine stain along trigeminal nerve
can have hemianopia, hemiparesis and hemisensory disturbances
intracranial calcifications resembling tramline
sturge weber
bilateral loss central vision
macular degeneration
HTN hemorrhage with contralateral hemiparesis and hemianesthesis and conjugate gaze deviation to side of lesion
putamen (basal ganglia bleed) because affects internal capsule
effects of parietal hemorrhage
contralateral hemi sensory loss
Cauda equina syndrome
compression spinal nerve roots from metastatic prostate CA
can lose anal sphincter innercation, lose parasympathetic to bowel and bladder
LMN Sx
conus medullaris syndrome
sudden onset with severe back pain and have hyperreflexia
signs hypokalemia
weakness, fatigue, muscle cramps
flaccid paralysis hyporeflexia, tetany and rhabdomyolysis
EKG shows broad T waves and U waves, ST depression and PVC
periodic sharp waves on EEG
prion disease
rapidly progressing dementia and myoclonus
prion disease
gradually worsening severe low back pain that is worse at night laying down and have symmetric weakness with absent DTRs early on. later develop hyperreflexia and babinski
spinal cord compression
Tx spinal cord compression
EM MRI
IV glucocorticoid
rad/onc or neurosurg consults
first line for alzheimers
cholinesterase inhibitors like donepezil, galantamine, rivastigmine
what is sympathetic opthalmia
immune mediated inflammation of one eye after penetrating injury to other. “uncover hidden Ag”
Shy Drager syndrome
multiple system atrophy
parkinsonism, autonomic dysfunction and widespread neurologic signs including cerebellar, pyramidal and LMN
patient with parkinsonism has othostatic hypotension incontinence and other ANS Sx
suspect shy drager
infant with fialure to thrive, bilateral cataracts jaundice an dhypoglycemia
Galactose 1 phosphate uridyl transferase deficiency aka Galactossemia
patient with galactossemia are at increased risk for what
E coli neonatal sepsis
gradual loss peripheral vision
open angle glaucoma
atrophy caudate
huntingtons
baby crying goes pale and passes out
breath holding spell, normal in 6 mo - 2 yr
side effect expected early on after initiation levodopa/carbidopa
hallucinations and dyskinesia
amantadine side effects
ankle edema and livedo reticularis
Wernicke encephalopathy
encephalopaty, ocular dysfunction, gait ataxia
from alcohol
Tx wernicke
thiamine and glucose
drug for trigem neuralgia
carbamazepine
prophylaxis for cluster HA
verapamil, lithium, and ergotamine
treatment for acute cluster HA
100% O2 and subcutaneous sumatriptan
transient pain in right UE and LE. right hemianesthesia, mild athetosis right hand
strength is preserved in all 4
lesion is where?
thalamus “thalamic pain phenomenon”
Tx for migrain in children
supportive like laying in dark and then administration of acetominophen or NSAID
gonococcal conjunctivitis
copious exudates and eyelid swelling at age 2-5
Tx gonococcal conjunctivitis
hospitalization
dose of ceftriaxone or cefotaxime
NF1 characteristics
cafe au lait spots, macrocephaly, feeding problems, short stature and learning disabilities
acute ischemic stroke, hemorrhage rule out, next step?
fibrinolytic therapy if within 3-4.5 hours
Leschy nyhan mutation
x linked recessive. hypoxanthin guanin phosphoribosyl transferase
glucocorticoid induced myopathy
progressive muscle weakness and atrophy without pain
lower extremity more common
arm helf in external rotation cannot internall rotate
axillary nerve damaged
triad epidural abscess
fever, severe focal back pain and neuro deficits
progressive symptoms of radiculopathies and motor/sensory deficits
Dx spinal epidural abscess
MRI spine with gadolinium
Tx spinal epidural abcess
immediate surgical decompression
what pathogen is assoc with guillain barre
Campylobacter jejuni
high velovit injury to the high has a higher probability for what
globe penetration an intraocular foreign body so use fluorescein to look
causes of delerium
drugs infection electrolytes metabolic derrangments systemic illness CNS
Sx of facial palsy upper and lower
cannot do brow movements
cannot close eyes
visual hallucinations are in what dementia
lewy body
what is trachoma
caused by chlamydia trachomatis, cuase blindness worldwide
sigsn trachoma
follicular conjunctivitis and pannus(neovascularization) in cornea
Tx trachoma
topical tetracycline and oral azithromycin
acute angle closure
more common in asian women
severe eye pain with halos around lights
pupil is dilated and poorly responds to light
HA with nausea and vomiting
Tx pseudotumor cerebri
acetazolamide is first line
inhibits choiroid plexus carbonic anhydrase
diffuse cortical and subcortical atrophy in temporal and parietal lobes
alzheimer
Dx vasospasm post subarachnoid hemorrhage
CTA
how to prevent vasospams post subarachnoid hemorrhage
nimodipine
tremor in parkinsons
4-5 Hz. better with intention. resting tremor
straight lines now appear wavy
macular degeneration
HIV patient with ekratitis fundoscoy show pale peripheral retinal lesions and central necrosis of retina
Herpes simplex
most common predisposing factor to orbital cellulitis
bacterial sinusitis
signs orbital cellulitis
proptosis, ophthalmoplegia and diplopia
affect of young child with meningtisi
regression of milestones
most common cause lumbar spine stenosis
degenerative joint disease
signs lumbar spine stenosis
worse when walking downhill because extends spine. weakness, senory loss, numness
confirm by MRI
male with sudden onset red left eye with photophobia nausea and severe HA. no trauma. nonreactive mid dilated left pupil
acute angle closure glaucoma
what medication can precipitate acute angle closure
decongestants
trigem neuralgia is common in what population
women with MS
sensory of cornea is innervated by
trigeminal nerve, V1
pathogens causing brain abscesses
strep viridans
staph aureus
gram negative
solitary ring enhancing lesion on brain CT with fluid collection in ethmoid sinus
brain abscess
why are patients with Digeorge higher risk brain abscess
have the VSD which provides access to brain arterials without going through lung first, escaping lung mechanisms to rid infections and pathogens.
if vignette says child with multiple sinusitis, suspect brain abscess
auras are indicative of what type seizure
focal area so partial seizure
complex partial seizure
automatisms with the LOC
partial seizure iwth secondary generalization
tonic clonic manifestations like diffuse muscle aches and elvated CPK
treatment trigeminal neuralgia
carbamazepine
adverse effect carbamazepine
aplastic anemia, need routine CBC
Fetal alcohol syndrome characteristics
small palpebral fissures
smooth philtrum
thin vermilion border
can have microcephaly
long narrow face, prominent forehead and chin
large ears
macrocephaly
macroorchidism
fragile X syndrome
causes of hemiplegia in children
seizure, intracranial hemorrhagic, ischemic stroke, hemiplegic migraine
Signs craniopharyngioma
remnants of rathke pouch
can cause bitemporal hemianopsia
can cause endocrinopathies from compression pituitary stalk
suprasellar calcified mass on imaging
what is opthomalogic manifestation NF1
optic glioma
gait distrubance with medulloblastoma
truncal ataxia
bitemporal hemianopsia and decreased libido
likely craniopharyngioma
Tx restless leg syndrome
first line is dopamine agonist pramipexole
alternate is alpha 2 delta Ca channel ligands like gabapentin
presbyopia
loss of lens elasticity
needed to focus on near objects
DM II with fatigue urinary frequency and increased blurry vision and leg cramps. all after respiratory infection. high BP. dry mucous membranes urine + glucose negative for ketones
whats causing vision blurriness?
hyperosmolarity from non ketotic hyperglycemia causing osmotic diuresis and dehydration
postconcussive syndrome
HA confusion, amnesia, difficulty concentrating with multitasking, vertigo, mood alteration, sleep disturbance and anxiety
side effect metoclopramide
dystonic reaction because it is a dopamine R antagonist
can cause agitation, tardive dyskinesia and dystonic reactions and parkinsonism
how to counteract dystonic reaction from metoclopramide
benztropine or diphenhydramine
basal ganglia hemorrhage signs
contralateral hemiparesis and hemisensory loss
homonoymous hemianopsia
gaze palsy
thalamus hemorrhage signs
contra hemiparesis and hemi sensory
nonreactive miotic pupils
upgaze palsy
eyes deviate towards hemiparesis
pinpoint reactive pupils. where is hemorrhage
pons
most common etiology of basal ganglia hemorrhage
HTN vasculopathy
best Dx acoustic neuroma
MRI with gadolinium
homocystinuria
intellecual disability thrombosis megaloblastic anemia fair complexion tall stature join hyperlaxity scoliosis
What is mechanism of diabetic oculomotor nerve neuropathy
ischemic of the somatic fibers, does not affect parasympathetic so reactive to light still
conjuctival appearance in allergic conjunctivits
follicular or bumpy conjunctival edema (chemosis)
lacunar strokes affect what areas
basal ganglia
internal capsule
pons
risk factor lacunar strokes
HTN
DM smoking, age, and high LDL
cause lipohyalinosis
painful eye with very red sclera and opacification and ulceration of the cornea
contact lens assoc keratitis
usually due to pseudomonas and serratia
medical EM
Tx pseudomonal keratitis
topical broad spectrum antibiotics
Anterior cord syndrome
burst fracture in vertebrae
lose motor below and loss pain and temp on both sides below lesion
get MRI
NF patient with HA nausea and vomiting. next step
order brain and orbital MRI
another name for vasovagal syncope
neurocardiogenic
loss of conjugate gaze
MLF disruption
what meds can cause pseudotumor cerebri
hypervitaminosis A (acne)
most important risk factor for stroke
HTN >smoking
central cord syndrome
weakness in UE more than lower. selective loss of pain and temp in arms from damage to spinothalamic tract
type of injury for central cord syndrome
hyperextension
mutation in fragile X
CCG repeats causing abberant methylation
what is maintained in anterior cord syndrome
position vibration and touch
LP results in GBS
increased protein. normal everything else
what causes decreased glucose in LP analysis
bacterial meningitis or TB meningitis
what is pathology benight paroxysmal positional vertigo
crystalline deposits in semicircular canals that disrupt flow
Lambert Easton
autoAb against voltage gated Ca Ch in presynaptic motor nerve terminal, defective release Ach
tick borne paralysis
rapidly progressive ascending paralysis, can be asymmetrical and there are no sensory abnormalities and CSF is normal
complication of untreated pseudotumor cerebri
blindness
chalazion
painful swelling progress to nodular rubbery lesion
recurrent chalazion, next step
histopath examination
finding on patient with alcoholic cerebellar degeneration
gait dysfunction, truncal ataxia, nystagmus and intention tremor or dysmetria
pain and decreased visual acuity post cataract surgery
postop enopthalmitis
need humor sent for culture and gram stain
patient falling toward side of lesion
cerebellar tumor
2 year old with fever, irritability and lethargy, intermittend abdominal discomfort and losing weight. firm nodular mass in right flank with no bruits
multiple calcifications in renal area and increased homovanillic and VMA
neuroblastoma from neural crest cells
mets of neuroblastoma
bones, skull bone marrow liver, lymph nodes and skin
fundoscopy shows zones of whitened edematous retina and disctribution of retinal arterioles
displaced retinal embolus
Von Gierkes
glucose 6 phosphotase deficiency, type I glycogen storage disease
Sx von gierkes
hypoglycemia and lactic acidosis
hyperuricemia
hyperlipidemia
doll like face, thin extremities and short stature with protuberant abdomen
vitreous hemorrhage
sudden loss of vision and floaters. from diabetic retinopathy
loss of fundus details, and dark red glow
lab value increase in Vit B12 deficiency
methylmalonic acid
swelling over one cranial bone post birth with no discoloration
cephalohematoma
diffuse bruised swelling of newborn scalp
caput succedaneum
first line for acute angle closure glaucoma
mannitol IV
how does pilocarpine decrease inraocular P
open canals of schlemm to allow drainage
how dose timolol help IOP
decrease production aqueous humor
most common adult onset muscular dystrophy
steinert disease. musc dystrophy type 1
mutation in aduld onset musc dystrophy
auto dominant
CTG trinucelotide repease in DMPK gene on chrom 19q
signs of sadult onset musc dystrophy
facial weakness, weak handgrip
myotonia and dysphagia
testicular atrophy
inheritance duchenne and becker
x linked recessive
onset musc dystrophy age 2-3
duchenne
onset musc dystrophy age 5-15
becker
girl recently brok up with bF and passes out. slightly disoriented after
seizure. not syncope
what is riluzole
glutamate inhibitor used in ALS
NF2 mutation
chrom 22. nonsense of tumor supressor gene
wilsons disease labs
elevated LFTs
low ceruloplasm
signs of wilsons
tremor, rigidity, depression, paranoia, catatonia
insect bite to cheek. now both eyes swollen, no appetite, vomiting with fever. erythema and EOM restricted
tender to palpation over forehead
cavernous sinus thrombosis
dacrocystitis
infection lacrimal sac
changes in color perception. pain on eye movement
optic neuritis
psuedodementia
seem severely depressed without memory loss
